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Grant Agreement number 774210 – CO-CREATE
2019 This project has received funding from the European
Union’s Horizon 2020 research and innovation
programme under grant agreement No 774210
NOURISHING & MOVING Methods
Document
World Cancer Research Fund International
28.02.2019
WCRF International 2nd Floor, 22 Bedford Square, London, WC1B 3HH, UK / +44 (0) 20 7343 4200
CO-CREATE is funded by the European Union’s Horizon 2020 Research and Innovation Programme (grant agreement #774210)
Grant Agreement number 774210 – CO-CREATE
Executive Summary
This Methods Document sets out the process taken by WCRF International to identify and present national-level,
implemented policy actions in physical activity and healthy diets around the world. It is one of the first
deliverables in CO-CREATE (Confronting Obesity: Co-creating Policy with Youth), a project funded by the
European Union’s Horizon 2020 Research and Innovation Programme, under grant agreement #774210. It was
presented to the European Commission by 28 February 2019, following review by both the CO-CREATE team and
external experts.
The Methods Document begins by summarising the frameworks that have been developed by WCRF
International in healthy diets (the NOURISHING framework) and in physical activity (the MOVING framework).
Based on these frameworks, policy databases present the policy actions in a structured and consistent way. The
information in the databases is verified externally and presented on a web platform in an easily accessible and
searchable format.1
This Methods Document sets out the processes for two distinct scans of policy actions, which will enable WCRF
International to populate the databases in a consistent way over time:
▪ first, a global scan of policy actions aimed at promoting physical activity and healthy diets, which uses a
wide variety of sources to provide a full overview from around the world as policy actions come into
force.
▪ secondly, a comprehensive European scan (required by the CO-CREATE project), which takes a
structured, systematic approach to searching for policy actions in 27 countries. This builds on the
findings of the global scan but with additional specific steps within each of these countries, including
searching legislation databases (using standard search terms) and ministries. This comprehensive scan
will be undertaken once.
The Methods Document states the criteria for inclusion/exclusion and verification requirements, and lists many
of the most relevant sources, as well as providing a flowchart of the strategy that is used in undertaking the
scans. Limitations and challenges of the process are set out.
A Technical Annex to this Methods Document is also available, which sets out the process in more detail,
including the search terms and how the information is captured when carrying out the comprehensive European
scan. It also details a set of interviews that were held as part of the research for this project – this Methods
Document draws on the knowledge of others who have established and maintain databases of health
legislation/policy/actions.
Information specifically relevant to the comprehensive European scan is presented in purple shaded boxes
throughout for ease of reference.
1Note that the NOURISHING database predates the CO-CREATE project and will be updated by these scans. The MOVING
database/web platform, however will be entirely populated by the forthcoming scans as part of the CO-CREATE project.
2
Grant Agreement number 774210 – CO-CREATE
Note:
This Methods Document is presented as a living document. It will be updated during the CO-CREATE project to
draw on:
a) new sources of data on policy actions that become available;
b) learnings from the creation of the MOVING database and web platform;
c) feedback from the benchmarking process (a separate deliverable within CO-CREATE – see Technical Annex);
and
d) learning throughout the policy scan itself.
3
Grant Agreement number 774210 – CO-CREATE
Table of Contents
Executive Summary .................................................................................................................................... 2
List of acronyms / abbreviations ....................................................................................................... 5
Definitions ....................................................................................................................................... 6
Acknowledgements .................................................................................................................................... 6
The Methods Document in the context of CO-CREATE ................................................................................. 8
The NOURISHING / MOVING frameworks and policy databases ................................................................... 9
The NOURISHING framework and policy database ..............................................................................................................9
The MOVING framework and policy database .................................................................................................................. 10
Web platform..................................................................................................................................................................... 11
Target audiences................................................................................................................................................................ 12
Why a Methods Document for the databases on nutrition and physical activity policy actions? ................. 13
Objective of the Methods Document ................................................................................................................................ 13
3.2 Value of the Methods Document ................................................................................................................................ 13
What is included in the databases? ........................................................................................................... 14
Scope of policy scans ......................................................................................................................................................... 14
Global scan ......................................................................................................................................................................... 14
Comprehensive European scan ......................................................................................................................................... 15
How do policies make it into the database? .............................................................................................. 15
Search strategy and sources .............................................................................................................................................. 16
Policy selection .................................................................................................................................................................. 18
Verifying the policies ......................................................................................................................................................... 21
Final check: comprehensive European scan ...................................................................................................................... 22
Presentation of policies ............................................................................................................................ 22
Format of public-facing material ....................................................................................................................................... 22
Tagging ............................................................................................................................................................................... 23
Limitations and challenges........................................................................................................................ 23
Limitations ......................................................................................................................................................................... 23
Challenges .......................................................................................................................................................................... 24
Appendix A1: NOURISHING and MOVING sub-policy areas and policy options ........................................... 25
A1.1 NOURISHING.............................................................................................................................................................. 25
A1.2 MOVING..................................................................................................................................................................... 27
Appendix A2: In-country sources .............................................................................................................. 29
Appendix A3: Database tags ..................................................................................................................... 30
A3.1 Tags used in the NOURISHING database (50 – June 2020) ....................................................................................... 30
A3.2 Tags proposed for use in the MOVING database (56 – as of June 2020).................................................................. 30
Appendix A4: Development of the Methods Document ............................................................................. 31
A4.1 Process timeline ........................................................................................................................................................ 31
A4.2 Research .................................................................................................................................................................... 31
A4.3 Reviewers .................................................................................................................................................................. 32
A4.4 Iteration ..................................................................................................................................................................... 32
A4.5 Face-to-face expert meeting ..................................................................................................................................... 32
Appendix A5. Policy database interviews .................................................................................................. 33
4Grant Agreement number 774210 – CO-CREATE
List of acronyms / abbreviations
CO-CREATE Confronting Obesity: Co-creating Policy with Youth project
COSI WHO European Childhood Obesity Surveillance Initiative
GAPPA Global Action Plan on Physical Activity (WHO 2018)
HBSC WHO collaborative cross-national survey: Health Behaviour in School-aged Children
HEPA health-enhancing physical activity
HEPA Europe European network for the promotion of health-enhancing physical activity
HEPA-PAT HEPA Europe Policy Audit Tool
HFSS high in fat, salt and/or sugar
ISPAH International Society for Physical Activity and Health
MOVING the MOVING Framework/database on physical activity policy actions
NCD non-communicable disease
NOURISHING the NOURISHING Framework/database on diet and nutrition policy actions
PA physical activity
SSB sugar-sweetened beverage
WCRF World Cancer Research Fund
WHO World Health Organization
WP work package of the CO-CREATE project
5Grant Agreement number 774210 – CO-CREATE
Definitions
Term Definition
government- Support must be publicly communicated and may consist of financial sponsorship or an
supported policy endorsement (public statement of support) by government. Programmes or interventions run
action by non-governmental actors, such as civil society organisations or companies, are not included
unless these actions are supported in some way by government.
health-enhancing A diet rich in wholegrains, vegetables, fruit and legumes and low in energy-dense,
diet micronutrient-poor foods.
health-enhancing Any form of physical activity that benefits health and functional capacity without undue harm
physical activity or risk.
policy The aims, objectives, targets, strategy, tactics, plans and action plans that guide the actions of
a government.
policy action Any form of government action including, but not restricted to, legislation, regulation, decrees,
standards, policies, programmes, guidelines, fiscal measures and government-supported
voluntary programmes, action and campaigns. All policy actions are part of public policy, but
not all policies are policy actions.
policy Policy implementation is a complex change process and therefore can involve several stages or
implementation levels of implementation. For the purpose of updating the databases, we define
implementation as the point when an adopted policy action first comes into effect. For
example, draft or model laws, policy proposals, and laws that have been passed but not come
into effect are not included in the databases.
The definitions were drawn up using a) existing definitions that have been reinforced through use in the NOURISHING database, b)
expert advice, c) comparison with other databases’ definitions and d) other official sources (e.g. WHO).
Acknowledgements
This project is funded by the European Union’s Horizon 2020 Research and Innovation Programme, grant
agreement #774210.
Author: Katy Cooper, Policy Analyst, World Cancer Research Fund International
With thanks to:
• the WCRF International Policy & Public Affairs team (Louise Meincke, Bryony Sinclair and Fiona Sing) and
other WCRF staff, particularly Dr Giota Mitrou and Professor Martin Wiseman;
• the External Review Group
• Ms Anita George, Manager – Prevention, McCabe Centre for Law and Cancer, Melbourne, Australia
• Mr Jo Jewell, Technical Officer, Nutrition, Physical Activity and Obesity, WHO Regional Office for
Europe
• Ms Sally Mancini, Director of Advocacy Resources, Rudd Center for Food Policy & Obesity at the
University of Connecticut
• Dr Karen Milton, Lecturer in Public Health, Norwich Medical School, University of East Anglia
6Grant Agreement number 774210 – CO-CREATE
• Dr Feisul Idzwan Mustapha, Deputy Director (NCD), Non-Communicable Disease Section, Disease
Control Division, Ministry of Health, Malaysia
• Professor Shiriki Kumanyika, Research Professor, Department of Community Health and Prevention,
Dornsife School of Public Health, Drexel University, Philadelphia
• Professor Anna Peeters, Director, Institute for Health Transformation, and Professor of
Epidemiology and Equity in Public Health, Deakin University
• Professor Mike Rayner, Director, Centre on Population Approaches for Non-Communicable Disease
Prevention, University of Oxford
• Professor Catherine Woods, Chair, Physical Activity for Health, Department of Physical Education
and Sport Sciences, University of Limerick
• those interviewed about policy databases (see Appendix A5);
• the experts who attended the ISPAH special interest group meeting held at WCRF International’s office on
18 October 2018; and
• the experts who attended the face-to-face meeting on benchmarking tools and indicators, held in London in
February 2019.
7Grant Agreement number 774210 – CO-CREATE
The Methods Document in the context of CO-CREATE
CO-CREATE (Confronting Obesity: Co-creating Policy with Youth) is a project funded by the European Union’s
Horizon 2020 Research and Innovation Programme, under grant agreement #774210.
The overarching aim of CO-CREATE is:
‘to reduce childhood obesity and its co-morbidities by working with adolescents, to create, inform and
disseminate obesity-preventive evidence-based policies…. [It] applies a systems approach to provide a
better understanding of how factors associated with obesity interact at various levels.’
The Methods Document is part of Work Package 2 (WP2) on Policy Assessment and Monitoring and is described
in the CO-CREATE Grant Agreement as follows:
‘Task 2.2: Establish methods for a global and specific European level policy scan related to diets and
physical activity
Methods will be established for a global policy scan related to diets and physical activity based on WCRF
International methods for maintaining the NOURISHING policy database, including inclusion criteria
[section 5.2.1], search strategy [section 5.1], data extraction [Technical Annex] and verification process
[section 5.3]. These methods will include a section detailing a targeted and much more comprehensive
process for sourcing policies being implemented in European countries [integrated throughout –
highlighted].
As with NOURISHING, only implemented government policies will be included in the database and the
verification process will involve direct communication with in-country contacts to verify each policy’s
implementation and the accuracy of the policy description (we will collaborate with the WHO Regional
Office of Europe 2 to identify appropriate contacts in each European country for in-depth European policy
scan).’
The Methods Document is Deliverable D2.3:
Methods document for policy scan: A document will be prepared to make publicly available
methodology for a global and targeted European policy scan.
More information about CO-CREATE is available on the website of the lead partner, the Norwegian Institute of
Public Health: https://www.fhi.no/en/studies/co-create/ This includes information on youth involvement
throughout the project, which is concentrated in work packages 4–7.3
2The form of this collaboration will include translation of search terms into local languages and assistance with verification of the
summaries of policy actions.
3
The CO-CREATE project focuses on adolescents (aged 10–19), and the benchmarking tools and indexing processes that form part
of later work packages will focus on policy interventions that directly or indirectly impact on this age group. The NOURISHING and
MOVING frameworks will continue to exist after CO-CREATE, and the policy scans will therefore search for all nutrition and
physical activity policy actions, regardless of age.
8Grant Agreement number 774210 – CO-CREATE
The NOURISHING / MOVING frameworks and policy databases
The NOURISHING framework and policy database
WCRF International’s NOURISHING framework identifies ten areas for governments to take action to promote
healthy diets and reduce overweight, obesity and diet-related NCDs.4 Its accompanying policy database aims to
provide an extensive overview of implemented government policy actions from around the world, as well as
links to published evaluations of included policy actions. It has been designed to be used as a tool for
policymakers, civil society organisations and researchers (section 2.4). The NOURISHING framework:
• formalises a comprehensive package of policies to promote healthier eating and prevent overweight, obesity
and diet-related NCDs that is applicable globally;
• provides options that allow policymakers flexibility to shape a response suitable and relevant for their
national, regional and local contexts and target populations; and
• establishes a framework for reporting, categorising and monitoring policy actions around the world, and
through which the policy evidence can be systematically categorised, updated, interpreted and then
communicated.
The policy actions contained within the NOURISHING framework are categorised into 10 key policy areas that fall
within three domains – the food environment, food system and behaviour change communication:
World Cancer Research Fund International launched its NOURISHING database in January 2014, structured
around the NOURISHING framework. It is a library of government-implemented nutrition policy actions from
around the world. The database aims to support and encourage national and international policymakers in
taking comprehensive action to promote healthy diets and reduce overweight, obesity and diet-related NCDs.
4 It does not include policies to address undernutrition unless the policy action is serving a dual purpose.
9Grant Agreement number 774210 – CO-CREATE
A document describing the methods behind the NOURISHING policy database is available and is updated
regularly.5 This was drawn up following advice from WCRF International’s Policy Advisory Group, to a) ensure
that the WCRF international approach is as transparent as possible and b) increase the accuracy and replicability
of the information sought.
The MOVING framework and policy database
The CO-CREATE project has provided a timely opportunity to build on the strong foundations provided by
NOURISHING and develop a complementary framework on promoting physical activity. The MOVING framework
is structured around three domains: active societies, active environments and active people. Within these
domains are six key policy areas.6
5 Available to download at https://www.wcrf.org/int/policy/nourishing/methodology
6 The MOVING physical activity framework is Deliverable D2.1 within WP2, submitted 31 October 2018.
10Grant Agreement number 774210 – CO-CREATE
In addition, there is an overarching domain: active systems:7
Governance systems – includes accountability, managing conflicts of interest, roles and
responsibilities for different actors.
Leadership – promoting clear leadership to ensure physical activity is given priority.
Physical activity surveillance – ensuring robust data collection on physical activity rates
across the population is put in place.
ACTIVE SYSTEMS Interdisciplinary research funding – increased research capacity across all sectors on the
rates of physical inactivity or activity and policy interventions etc.
Financing mechanisms to fund research, surveillance and interventions.
Monitoring and evaluation of policy actions – incorporating monitoring and evaluation
of policy actions at the outset to ensure effect is measured.
Life course/health in all policies approach – using a lens that ensures physical activity is
promoted across the whole population, across the life course, especially those that
are the least active, vulnerable or have different needs.
This framework was developed by WCRF International, as part of CO-CREATE, in 2018 and is based on an analysis
of the global physical activity policy literature (including the World Health Organization’s 2018 Global Action Plan
for Physical Activity, GAPPA). The MOVING framework’s six policy areas and the active systems domain align
with the four policy domains in the GAPPA: active societies, active environments, active people and active
systems.8
Policy actions underpinning the MOVING framework will be stored in a database that will sit beside and
complement the NOURISHING database. The databases will be hosted on a searchable web platform.
Web platform
Aim of the web platform
The aim of presenting the NOURISHING and MOVING databases in an accessible, searchable web platform is to
provide information on implemented policy actions that promote, support or encourage healthy diets and
physical activity. Together, the databases form a library of implemented government policy actions that
promote nutrition and physical activity around the world.
Updating the web platform
The NOURISHING database is populated by a global scan that is conducted on a rolling basis (and this approach
will be extended to the MOVING database). Ongoing oversight of newsletters, listservs and research into key
topics (for sources, see Technical Annex) ensures that the Policy & Public Affairs Team in WCRF International
stay abreast of current debates and reforms – keeping track of future developments (revisions of existing
7
The ‘active systems’ domain has been included to align with GAPPA and note that the scope of this domain is so extensive that
implemented policy actions cannot be included within the MOVING database in a fully comprehensive way. Instead, best-practice
examples will be identified that illustrate the range of issues covered by active systems.
8 For a detailed mapping of how the GAPPA actions fit with the six MOVING policy areas, see the MOVING framework deliverable.
11Grant Agreement number 774210 – CO-CREATE
policies as well as new policy actions, and tracking strategies to see what is then turned into actual policy
action). This information is assessed (section 5.2) and uploaded to the web platform about three times a year.
This process will now be supplemented with one comprehensive search of national-level diet/nutrition and
physical activity policy action in a number of European countries (section 4.3) as required by CO-CREATE.
Within the context of CO-CREATE, the information gathered into the NOURISHING and MOVING
databases will be used to compare policy environments across Europe (see Technical Annex
(section T7) for more information on this aspect of CO-CREATE). CO-CREATE will also work with
young people to use this web platform for better in-country advocacy and awareness raising of what
more can be done to improve implementation of policy that impacts on overweight and obesity in
children and adolescents.
Target audiences
The information captured in the NOURISHING and MOVING databases can be used by stakeholders for a variety
of purposes, including tracking progress and speeding up the diffusion of innovation. For example:
• policymakers can:
• identify where action is needed to promote healthy diets and physical activity;
• select and tailor options for their population and contexts, assessing if their approach is sufficiently
comprehensive; and
• see how the country is matching up to other jurisdictions (for example, other countries within the
EU or a WHO region) in the scope of their efforts;
• advocacy groups and civil society organisations can:
• track policy action and better choose where to focus their resources;
• monitor what governments are doing around the world;
• use the information in the databases to create benchmarks;
• hold governments to account;
• promote examples of successful interventions;
• identify strategies that can be adapted to their local context; and
• share progress;
• researchers can:
• access a comprehensive library of data;
• compare policy actions with health outcomes over time;
• identify the evidence available for different policies from the policy evaluations included in the
database; and
• track progress of in-country policy actions over time;
• the public (including the media) have ready access to key health policy actions in their country.
12Grant Agreement number 774210 – CO-CREATE
Why a Methods Document for the databases on nutrition and physical
activity policy actions?
To develop a consistent and structured approach to populating the two databases on nutrition and physical
activity policy actions
Objective of the Methods Document
The objective of this Methods Document is to:
• describe how the NOURISHING and MOVING databases are populated and updated;
• underpin users’ confidence about the quality of the information in the databases because of the transparent
structured process.
A Technical Annex that accompanies this Methods Document describes in detail the structured processes that
are used to gather and present the information.
The Methods Document spells out the what, how, who, where and when of the sourcing and verification of the
policy actions that are contained within the NOURISHING and MOVING databases – both the global scans and
the comprehensive European scan. It also details the way in which the presentation of the information is
standardised, to smooth the transfer of information between the policy analysts, the IT expertise behind the
database, and the final users of the database.
This Methods Document is both a tool that can be used to direct a scan of policy actions (i.e. the ‘how-to’) and
the public-facing rationale for what is included in the databases (i.e. the ‘why-we-did-it’).
3.2 Value of the Methods Document
The value of this consistency of approach lies in making it easier to compare policy actions across jurisdictions.
The structured approach ensures that the databases are suitable for use in further research by other
organisations9 and that the information can be used to hold governments to account where implementation is
found to be falling short and to call for the introduction of new or improved policy actions when a country
comparison finds that national action is lagging behind what other countries are doing.
A further benefit of the Methods Document is to set out sufficient detail to allow new researchers / policy
analysts to undertake a similar process for themselves. It also has the potential to be used as a template for
others to draw up methods documents in different areas (e.g. alcohol policy actions).
Appendix A4 sets out the process behind developing this Methods Document itself – the
research, interviews and expert opinion that was sought to make it as comprehensive and
practical as possible.
9WCRF International knows that the NOURISHING database is used regularly by policymakers, researchers and civil society
organisations from around the world, who have welcomed it as a reliable, accurate, well-structured and user-friendly repository of
implemented nutrition and health policies.
13Grant Agreement number 774210 – CO-CREATE
What is included in the databases?
Government-implemented or government-supported policy actions that promote
healthy eating and physical activity are included
Scope of policy scans
The updates of the NOURISHING database have always had a global focus and will continue to do so. The new
MOVING database will be built on the comprehensive European scan and will also include good-practice
examples globally.
The comprehensive scan for both NOURISHING and MOVING will happen once during CO-CREATE. This scan will
look specifically at policy action in 27 countries within Europe (listed below).
Note that details on the inclusion criteria for the policy actions are set out in section 5.2.1.
Global scan
Most policy actions in the global scan are at national level. However, the global scan also includes exemplars of
policy action at sub-national (regional, municipal or local) level, for example:
• NOURISHING: New York City’s Food Standards, which set nutritional standards for all food purchased or
served by city agencies.
14Grant Agreement number 774210 – CO-CREATE
Comprehensive European scan
CO-CREATE stipulates that, for 27 European countries (below), the policy scan of nutrition and physical
activity policy actions that is as comprehensive as possible – i.e. it will cover as many relevant polices as
possible. It will take a systematic approach, set out in the Technical Annex to this Methods Document. It
will focus on national-level policies only and will take place once during CO-CREATE.
The standardisation set out in the Technical Annex ensuring that benchmarks and baselines can be
created and updates more easily sought, tracked and analysed. (For more on benchmarking as part of the
CO-CREATE project, see Technical Annex.)
Countries included in the comprehensive European scan
1. Austria 10. Germany 20. Poland
2. Belgium 11. Greece 21. Portugal
3. Bulgaria 12. Hungary 22. Romania
4. Croatia 13. Ireland 23. Slovakia
5. Czech Republic 14. Italy 24. Slovenia
6. Denmark 15. Latvia 25. Spain
7. Estonia 16. Lithuania 26. Sweden
8. Finland 17. Malta 27. UK
9. France 18. Netherlands
19. Norway
The countries chosen for inclusion were dictated by the wider aims of CO-CREATE:
1) As an initiative funded by the EU Horizon 2020 Research and Innovation Programme, countries within
the European Union are the focus.
2) A further aim of the CO-CREATE project is to study the association between policy environments (of
which NOURISHING/MOVING scans are a part) and the prevalence rates of childhood obesity. For this
study to be consistent, data collection on prevalence must also be consistent – and the HBSC (Health
Behaviour in School-aged Children) Survey has been chosen as the appropriate source of data.
Hence, only countries with data available in the HBSC Survey 2013/14 for youth aged 15 can be
included here (e.g. Northern Ireland and Cyprus are not part of the Survey and are therefore
omitted). This age has been selected due to the relevance to the overall project.
3) The five Co-Create Project Countries (Netherlands, Norway, Poland, Portugal and the United
Kingdom).
The NOURISHING database will continue to be updated regularly, based on the ten policy areas and following
the existing methods document.
The new MOVING database will also be updated across the six policy areas (the period of time between updates
will depend on the results of initial scans – it is too early to be prescriptive). Additionally, a small number of
policy actions related to ‘active systems’ will be included on the web platform, for example: governance
systems, leadership, physical activity surveillance, interdisciplinary research funding, and financing mechanisms
to fund research, surveillance and interventions.
How do policies make it into the database?
A structured search for policy actions is undertaken, with those identified as possibilities for inclusion then subject
to in-house research, assessment and verification by external experts
15Grant Agreement number 774210 – CO-CREATE
Search strategy and sources
Search strategy
Search strategies for the scans must be transparent and reproducible to ensure that the information gathered is
consistent across countries; this is particularly important if several policy analysts are involved in the search
process. An in-depth search protocol also ensures that the scan is as comprehensive as possible – using the same
search terms and using the equivalent sources within each country.
To help structure the databases, the policy areas of NOURISHING and MOVING are organised into sub-policy
areas (these are listed in Appendix A1). This effectively groups policy actions into more specific sub-policy areas,
which helps people navigating the databases. The existing NOURISHING database is organised by these sub-
policy areas and the new web platform will also take this approach.
Flowchart 1a outlines the strategy that is used by policy analysts in undertaking the global scans of nutrition and
physical activity policy actions (as has been used in the NOURISHING updating process since 2014) and the extra
steps required for the comprehensive European scan. The global scan is ongoing and CO-CREATE requires that
the comprehensive European scan be undertaken once.
More detail on this process, including search terms (which have already been identified), is provided in the
Technical Annex to this Methods Document.
Sources of information
Having a clear idea of where to look online before beginning the scan will save time and effort. WCRF
International and experts have identified a range of sources, below, as being appropriate (and the Technical
Annex then provides a more detailed list of sources, including URLs).
16Grant Agreement number 774210 – CO-CREATE
1. There are many sources of relevant NCD documentation, including the
Example search terms for
WHO NCD Document Repository and WHO Europe’s physical activity
NCD documentation and
factsheets. Reports from international agencies can also provide valuable policy databases
insights (e.g. WHO, European Commission’s Joint Research Centre).
[country name] + physical activity
2. Policy databases and surveys collect information about and can be + policy
searched for recent policy actions – both internationally (e.g. the WHO
GINA database) or nationally (e.g. the Canadian Prevention Policies Directory or the Rudd Center for Food Policy
and Obesity’s Legislation Database).
3. Secondary sources: include national organisations, such as the national
Secondary sources
sports body, newsletters (e.g. World Obesity Federation (global) and NYC
Food Policy Watch (USA), listservs (e.g. Center for Science in the Public • provide context
Interest SSB listserv), national media (e.g. the BBC) and civil society • assist in initial identification of
websites (e.g. NCD Alliance or national consumer websites). relevant policies
• narrow the scope of the data
4. Ad hoc sources are often valuable, such as conversations with
being collected
policymakers or experts at meetings, communications sent by users of the
• check that everything is being
databases with suggestions for updates. There will also be incidental
picked up
discoveries of information, through unexpected and unanticipated
• are helpful where official
channels. In-country contacts are sources of up-to-date information on
websites contain
policy actions (including being able to comment on implementation – see information/policies only in the
section 5.3.2 and Technical Annex). Users of the database are encouraged local language
to submit implemented policy actions to the Policy & Public Affairs Team • can be used as a quality-
for review and verification. control check of the data
Google will be used for an initial overview and to check for any new policy
databases (national, regional or global), to search for recent news, and to find information in more detail than
may appear in official government websites.
Academic sources are particularly important for searching for evaluations of policy actions. Electronic databases
such as PubMed are used to access relevant articles.
Note that the Technical Annex sets out how policy actions are stored and recorded within WCRF International.
17Grant Agreement number 774210 – CO-CREATE
Extra steps and sources for the comprehensive European scan
Compiling a list of national sources – e.g. relevant ministries – is one of the first steps to be taken in the comprehensive
scan of a specific country.
Many countries have a formal legislation database, which should be Example search terms for
searched in the first instance using a detailed set of search terms. legislation databases
Where no legislation database is available, ministry websites will be physical activity
searched instead (using a reduced number of basic search terms),
AND primary care
including the Ministry of Health, the Ministry of Finance, Ministry of
Transport, Ministry of Environment and the Ministry of Education. AND assessment OR
referral OR counselling
(The detailed and basic search terms are set out in the Technical
Annex – these may be adapted during the comprehensive Example basic search terms for
European scan. The search terms are ministry websites
based on the sub-policy areas of NOURISHING and MOVING, nutrition
to ensure a structured approach.
AND primary care OR
In-country secondary sources are also searched, including news counselling
media and any national sports agency.
This approach to the comprehensive European scan was developed and tested during preliminary scans of Ireland,
Malta, France and Denmark, undertaken in December 2018/January 2019.
More detail on the in-country sources that should be scanned as part of the comprehensive European search is in
Appendix A2.
Policy selection
The policy selection and verification processes are shown on Flowchart 1b.
18Grant Agreement number 774210 – CO-CREATE
A structured approach is taken to identifying policies, using the sources set out above (and in the Technical
Annex) and the methods already tested in NOURISHING (extended to include physical activity). This includes a
targeted search (using academic electronic databases) to check for peer-reviewed evaluations of policy actions.
Once identified, each policy action is researched to ensure that sufficient information is available for its inclusion
in the database.
Official government websites are often where the official versions of policies are stored and should be consulted
to find the original document as part of the assessment of appropriateness of a policy action for inclusion in the
database, wherever possible. However, policies do not need to be publicly available online for inclusion in the
databases: some countries do not publish their legislation online, so secondary sources will be key sources of
information.
A note on language (see also Technical Annex): It is common for information on policies relevant to
NOURISHING/MOVING to be in languages other than English. When this is the case, a web search is conducted
to locate additional information about the policy, in-country expert(s) may be consulted, in-house foreign
language capabilities are used where available and, where necessary, Google Translate and/or linguee.com is
used to interpret foreign-language information sources on specific policies to assess their appropriateness for
the database.
Inclusion and exclusion criteria for policy actions
The inclusion criteria for the NOURISHING and MOVING databases set out the types of policy actions to be
included, the required implementation status, and the characteristics of the policies that will be included.
The aim of the inclusion criteria is to ensure that the scan can pick up as much relevant information as possible
in a streamlined way: it is as comprehensive as possible, but by the time of publication may not be exhaustive.
This list of inclusion criteria for policy actions draws heavily on the NOURISHING inclusion criteria, which have
been tested in practice over the last five years, providing valuable proof of concept. The additional requirement
to perform a scan in specific European countries (listed in section 5.3) that is ‘as comprehensive as possible’ has
meant that the criteria and search process have been amended to ensure that as many national-level policy
actions as possible are identified.
1. Must be a government action, an action implemented in partnership with government, or an action that is
formally supported, sponsored or endorsed by government
• Programmes or interventions run by non-governmental actors (such as civil society organisations or the
private sector) are included only if these actions are supported, sponsored or endorsed by government. Such
government support has to be publicly communicated and may consist of financial sponsorship or an
endorsement (public statement of support) by government.
2. Must be at relevant level of government
• Global scans: For inclusion in the NOURISHING and MOVING global scans, policies can be at national,
regional, provincial/territorial, municipal or local level. (NB It is not the intention to collect all regional,
provincial/territorial, municipal or local level policy actions, but exemplar policy actions are included.)
• Comprehensive European scan: The comprehensive scan will seek out national-level policies only.
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3. Must be related to reducing obesity and/or diet-related NCDs by promoting healthy diets or physical
activity
• The policy action may have multiple objectives (e.g. health, environmental sustainability etc.), but public
health must be a clear aim or co-benefit (e.g. improving nutrition, reducing overweight/obesity, increasing
availability of healthy food, increasing active travel, increasing the time children spend on physical activity in
school).
• Additionally, policy actions will be considered for inclusion in the database where there are clear benefits for
healthy diet and/or physical activity; inclusion of these policies is made on a case-by-case basis at the
discretion of the Policy & Public Affairs team within WCRF International.
4. Must be related to one of the policy areas outlined in the NOURISHING and MOVING frameworks
• Policies must fit within the scope of the NOURISHING framework’s 10 policy areas or of the MOVING
framework’s six policy areas. These are then categorised within sub-policy areas, by which the database and
web platform are structured (see Appendix A1).
• If a policy action cuts across both NOURISHING and MOVING, the action appears twice – once in each of the
two databases.
• Where a policy fits one of the NOURISHING/MOVING policy areas but does not directly fit one of the existing
sub-policy areas in that policy area, sub-policy areas can be added or edited to appropriately reflect the
policy actions.
5. Must be implemented and in force
• The policy action, law or regulation must be implemented wholly or in part. For example, draft or model
laws, policy proposals, election commitments and laws that have been passed but not come into effect are
not included in the databases.
• Policy implementation is a complex change process and therefore can involve several stages or levels of
implementation. For the purpose of updating the database, implementation is defined as the point in time
at which an adopted policy (or component of policy) first comes into effect.
• Exceptions:
• When a policy has ‘expired’, been withdrawn or is no longer enforced, it remains in the public-
facing database only if it has been evaluated (see section 4.2.3 and the Technical Annex). Where
possible, a brief explanation of the reason for the policy ‘expiring’ is included (e.g. a change of
government).
• Public awareness campaigns, either run by or endorsed by government (included in ‘I – Inform
people about food and nutrition through public awareness’ in NOURISHING and ‘N – Normalise and
increase physical activity through public communication’ in MOVING) may also remain in the policy
database even if they are no longer running as they often last for only a short time. The summary of
the campaign includes the start and end date. To be included, a campaign must have taken place in
the past five years and have had national scope; after this time, it is retained only if it has been
evaluated.
Section 5.3 sets out the verification process that is in place to ensure that an in-country expert has verified that
policies included in the database have been implemented or partially implemented in practice. More detail is
also provided in the Technical Annex.
6. Must be sufficient information about the policy action
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• There must be sufficient information about the policy action. In addition to the name of the policy, the date
of implementation of the policy and a link to any published evaluation of the policy, policy descriptions for
each of the policy areas within NOURISHING and MOVING require additional information (a guide to which is
set out in the Technical Annex). If this information cannot be provided (either by desk research or by the in-
country contacts), the policy action will not be included – this is at the discretion of the Policy & Public
Affairs Team at WCRF International.
• Examples of additional information include:
• within ‘O’ of NOURISHING (Offer healthy food and set standards in public institutions and other
specific settings): the type of institution and what is covered within the institution’s premises;
• within ‘N’ of MOVING (Normalise and increase physical activity through public communication that
motivates and builds behaviour change skills): the types of media used e.g. TV, radio, social media,
website, brochures.
Additional exclusion criteria
Policies related to the following are not included:
• undernutrition, breastfeeding and infant and young child feeding – these were not included in the existing
NOURISHING database and are not a requirement of CO-CREATE;
• alcohol policies – these are outside the scope of NOURISHING and are not a requirement of CO-CREATE;
• professional sport – the MOVING database is concerned with health-enhancing physical activity, not
professional sport.
Inclusion criteria for evaluations
Since October 2016, a phased approach has been taken to include existing evaluations of policy actions in the
NOURISHING database, and this is now also applied to the MOVING database.
Evaluations have to fulfil a number of requirements to be considered for inclusion, including that they must be
available online in English and are of sufficient quality (for more information, see the Technical Annex).
Updating the inclusion criteria
The process is iterative: a test scan was undertaken in December 2018 using the inclusion criteria, search
process, search terms and sources, which were then revised to overcome identified problems. For example:
• it became clear that searching each ministry in turn with over 100 search terms was impractical and would
reveal little more than searching the legislative database; hence, the decision was made to focus primarily
on legislative databases, searching the ministries only in the absence of a legislative database (and with a
reduced set of search terms);
• an initial inclusion criterion that ‘health is a stated aim’ of a policy action was altered to ‘public health must
be a clear aim or co-benefit’.
Advice has also been given by expert advisors (including from the World Health Organization) on the inclusion
criteria.
Verifying the policies
It is crucial to have verification on the information gathered on policy actions – and, although it can often be a
challenge to get the policy actions verified for inclusion in the database and web platform, this is an essential
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final step in the process. It is anticipated that in many countries two expert verifiers will be required – one in
nutrition and one in physical activity.
Drafting the description
The verification experts10 can be used early in the search process, when insufficient information can be found to
draft the policy description for the database. This may be because sources of information on policy actions are
insufficiently documented on official or secondary-source websites or because there are too few resources
available in English. The experts may also be able to direct the policy analysts to available documentation.
Verifying the descriptions
The policy action descriptions are sent to the experts to check for accuracy and to confirm that it is being
implemented; the definition of ‘implemented’ may be somewhat subjective, requiring a perspective to be
sought from more than one in-country expert.
There may be cases where the WCRF International Policy & Public Affairs Team have to determine whether to
include a policy: for example, if a tax on an unhealthy commodity has been enacted, is the tax being collected by
the government?
Verification of the description is required for all policy actions included in the NOURISHING and MOVING
databases.
Final check: comprehensive European scan
Before publication of the comprehensive European scan, a final email to the in-country verifiers should be sent,
to check that there have not been any unanticipated new policy actions that have been implemented since the
date of the scan and that must be included. If a new policy action is identified, its inclusion will depend on
whether it can be verified in the time available; if not, it will be included in a future global scan update.
Note that this is not required for the two global scans (for which new information can be added at the next
update) – but it is necessary to ensure that the European scan is as up to date as possible.
Note: Quality control is intrinsic to the process:
• drafts of the Methods Document were reviewed by experts in both nutrition and physical activity;
• the preliminary scan ensured that the methods are fit for purpose (and the methods document was
adapted accordingly); and
• verification by in-country experts ensures that all the policies in the database are appropriate for
inclusion.
Presentation of policies
Format of public-facing material
More information on the verification experts is provided in the Technical Annex. The experts are anticipated to include
10
WHO in-country experts.
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All entries in the NOURISHING and MOVING databases must include as a minimum:
• the name of the policy action (e.g. name of campaign, or title of an act);
• the date on which the policy action was implemented; and
• a reference and link to any published evaluation of the policy action (URLs to the original documentation of
policy actions are not included in the databases, as these are likely to change over time).
In addition, each of the policy actions then requires additional information (set out in the Technical Annex) – this
acts as a guide to ensure that the information that is collected is as consistent as possible: a helpful compare-
and-contrast for users. The policy actions in the database are all summarised in layman’s terms (i.e. in plain
English). The purpose of the database is not to discuss or comment on the policies, but users of the database are
well placed to then research this for themselves.
Tagging
Consistent storage of and accurate tagging of material is crucial to the ongoing utility and accuracy of the
databases. Structured storage and labelling of the information facilitates easier updating in the future and
tagging allows users of the database to find the information that they need quickly and easily.
Every policy action entered in the NOURISHING and MOVING databases is tagged with the relevant geography
and with a number of topic-specific tags. Currently, 50 topic tags make up the taxonomy of the NOURISHING
database (with three more proposed) and 56 of the MOVING database (see Appendix A3). The tags are amended
or added to as and when new areas for action come to the fore. The system of tags in the NOURISHING database
has been used since October 2017, so has been tested to show it is fit for purpose.
Limitations and challenges
Limitations
While the European scan will attempt to be as comprehensive as possible, the updates cannot be exhaustive or
fully up to date when launched:
• Legislation is constantly changing – e.g. it may be timebound or the government may change between scan
and publication. It can only be accurate as at the day on which each website is scanned, and the
comprehensive search will take a considerable amount of time.
• The level of implementation may also vary – it will be verified by in-country experts but the reality on the
ground may be patchy.
• It addresses only national action but, as noted above, much of the innovation and policy action may be at
regional/local (e.g. at city level). While examples are captured and included as exemplars as part of the
wider global scan, this cannot be, and is not intended to be, comprehensive.
In addition:
• Language will be a limitation in the scanning. WHO in-country contacts will be used to translate the search
terms ahead of the comprehensive European scan. Google Translate and linguee.com will be used to
translate search results (see Technical Annex).
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• WCRF International does not currently have the means to use a paid-for, automated service to sweep for the
latest legislation in specific jurisdictions – and there is no single global service that could perform this
function. However, machine-learning/AI techniques will make automated searching quicker, cheaper and
more effective over the next few years, so may be an option in the future.
• It is not possible to be completely sure of the level of implementation of policies – for example, the
reporting of in-country verification experts may include conscious or unconscious biases.
There are also specific limitations on the inclusion criteria, which are driven by the practicalities of undertaking
the scans:
• Were all proposed policies and policies included and policies that are no longer in force to remain in the
public-facing database, it could rapidly become unwieldy for users.11 However, there is an exception to the
rule that policies no longer in force are removed: policies that have been evaluated (process and impact
evaluations), which will be retained within the database (along with relevant links) because of the lasting
value of the evaluation to users.
• The comprehensive European scan cannot realistically cover regional, provincial/territorial, municipal and
local level policy action, as this would require a commitment of resource and time that is out of scope.
However, the global scans, which are ongoing and thorough but not as structured as the comprehensive
European scan, will continue to cover policy actions at sub-national level (see section 4.2).
Challenges
This process is not without its challenges.
• The inclusion/exclusion criteria need to be set to find the balance between capturing too many policies or
too few.
• Physical activity policy is often less obvious than for nutrition – for example, there is no equivalent in
physical activity to a ban on trans fats. While there are some clear physical activity policy actions (such as
national curriculum requirements), many of the policy actions that affect physical activity are indirect: speed
limits and vehicle emissions penalties.
• There is a relative lack of information on physical activity policy actions: There are many databases of
legislation, policy and policy action in the nutrition space, particularly in the United States – but fewer that
touch on physical activity (see list in Technical Annex). However, it is a growing space and WCRF
International has consulted widely with experts to find the best sources of information.
• There may not be much policy action at national level in physical activity, as innovation and action often sits
more locally. The inclusion criteria need to be drawn up in a way that captures as much as possible, as it is
not feasible to conduct a comprehensive scan at a sub-national level.
11Some policy databases (such as the Rudd Center for Food Policy and Obesity’s legislation database) do include proposed,
unimplemented and out-of-date policies – see Technical Annex – but an advantage of the NOURISHING/MOVING approach is that
the streamlining makes it easier for users to identify what is actually in force.
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